Between World War I and 1980, tens of thousands of American women were arrested without due process and quarantined on the suspicion that they were prostitutes, sexually promiscuous, or carried a sexually transmitted infection. The program to incarcerate suspicious women, which had support in every state and at every level of the federal government, was known as the “American Plan.” It is the subject of Scott W. Stern’s recent book, The Trials Of Nina McCall (Beacon Press, 2018). Stern, who is in his second year at Yale Law School, began researching the American Plan as an undergraduate at Yale College. He spoke with BRINK about the American Plan and the ways its victims resisted persecution. Below is an edited and condensed transcript of the interview.

BRINK: What was the American Plan?

STERN: The American Plan was the system under which U.S. government officials locked up tens, probably hundreds of thousands of women without due process in what were essentially concentration camps. They did this because they suspected the women had sexually transmitted infections, syphilis or gonorrhea, or because they suspected the women were prostitutes, or they simply suspected that the women were promiscuous. This started in World War I, and it was justified as protecting the national security by protecting soldiers from wayward women who were going to infect them with STIs. But it wasn’t entirely justified by that because the Plan continued for decades after WWI. It continued through WWII into the fifties, and in some places into the sixties and seventies. All of the laws that enabled the American Plan remain on the books to this day.

B: Who in government knew about this? How far up the chain of command did the American Plan go?

S: Everyone knew, from the President of the United States on down. This was in large part funded at the federal level by Woodrow Wilson, in a sense personally. He dispersed money from what was basically a WWI-era presidential slush fund in order to construct federally funded detention facilities for women. People who played a role in the American Plan included John D. Rockefeller, Jr., who funded the Plan at the federal level; Eliot Ness, who ran the federal agency that oversaw the American Plan during WWII; Earl Warren, as state attorney general and then governor of California. Eleanor Roosevelt was complicit. Her husband Franklin was complicit. Dwight D. Eisenhower was a big fan. Fiorello La Guardia was a big fan. People in every level of government and every branch of government were complicit, if not active fans. There were very few voices of dissent within the government and very few voices of dissent without the government—with the exception of a handful of committed activists, reformers, and journalists, and the incarcerated women themselves.

B: Did the average American know about the Plan?

S: That’s a complicated question. Sexually transmitted infections were incredibly stigmatized in the early- to mid-twentieth century. The surgeon general himself was not allowed to say the word syphilis on the radio in 1934. It was hard to write about in the newspaper. People did, they just did so with euphemism. Most people were aware what was going on. There are a lot of records of government agents writing to each other about what people on the street were talking about. Certainly, the women who were behind bars had their free speech curtailed. But this was something that was, at the time, widely known.

B: The Trials of Nina McCall is filled with the many ways women fought back against the American Plan. Who were these women, and what did their resistance look like?

S: As a rule, they were lower-income, they were disproportionately women of color, and they were women who were perceived by men and women in power as sexually promiscuous. But at the time that could mean so many things. It could be a woman out on a date with a man, a woman seen walking alone, a woman sitting in a restaurant alone, a woman drinking alcohol. All of those women were suspicious enough to get detained, forcibly examined for an STI and, if she tested positive, incarcerated without due process.

The prostitutes themselves began conducting a series of highly rigorous studies to document that they were not, in fact, common vectors of infection. The reason for that is pretty simple: the rate of female-to-male vaginal transmission is very low. And they conducted a number of studies to prove that. These studies were published in The Lancet, in the Journal of the American Medical Association. Women from [the rights organization Call Off Your Old Tired Ethics] COYOTE and other organizations testified before state legislatures in order to push back against proposals that they be mass-tested or quarantined. That has largely been forgotten.

What’s also largely been forgotten is the role in this of Robert Redfield, President Trump’s Director of the Center for Disease Control. In 1984, Robert Redfield, who was a physician at Walter Reed Naval Hospital, released a study that he had done on some 41 soldiers. He found that a large number of soldiers infected with HIV had been infected by female prostitutes. A number of people at the time pointed out that this was probably inaccurate, because the studies relied on men reporting this themselves. And of course these men were not going to report that they had been injecting drugs or sleeping with other men. But this study was widely publicized and it launched calls across the nation for the quarantining of prostitutes. Robert Redfield later oversaw the mass testing of military recruits, which led anyone trying to get into the military who tested positive to be barred from the military. Those already in the military were isolated in treatment wards that some called leper colonies. It led at least one soldier to try and kill himself.

For the American Plan’s entire existence, from the 1910s up through the sixties and seventies, women fought back vigorously. It’s impossible to say with any exactness, but hundreds if not thousands of women escaped from their detention facilities. Hundreds if not thousands of women rioted, physically fought back against their captors. A huge number of their detention facilities caught fire and a number of fires, we know, were set by the female inmates themselves. There are records of women holding hunger strikes. There are records of women speaking out in the press. I found the record of a woman who leapt from a moving train rather than go to one of these detention facilities. I found the record of a woman jumping out of a window to her death rather than remain in a detention facility. Women resisted in so many ways.

Another common method of resistance involved suing the government. This at a time when it was very difficult for stigmatized women to get access to counsel and then to have their case heard in court. Still, a lot of women sued the government, and we know this because of the number of cases that reached appellate courts. We also know that the government tried very hard to suppress these lawsuits. Federal agents put a ton of pressure on the American Bar Association to in turn put pressure on its lawyers not to represent these women. And, in some cases, the ABA did that. Federal agents also put pressure on judges not to go easy on these women. Nonetheless, women continued to sue and in a couple cases won. Still, the laws themselves were never overturned.

B: How did the American Plan end?

S: The American Plan operated on a local level for most of its history. Every state and hundreds of cities across the country passed laws enabling local officials to detain, examine, and incarcerate women. The Plan ended in various places in different times. In some places we can pinpoint an exact moment when it ended. In other places it just faded out. This happened in the fifties, in the sixties, and in the seventies. In San Francisco, into the mid-1970s officials continued to detain and hold women without due process for 72 hours and examine them for STIs. They had been ordered to stop doing this in the late forties, but officials just didn’t comply. The Plan really ended in San Francisco because of the rise of the Sex Workers’ Rights Movement. There was an organization called Call Off Your Old Tired Ethics, COYOTE, which was founded by a remarkable woman named Margo St. James, who is still alive, that advocated for the decriminalization of sex work and prostitution. It advocated for their voice in medicine and in the political process, and it was largely motivated in the early days by the lingering remnants of the American Plan. COYOTE launched protests, did their own investigations, and eventually they partnered with the ACLU [American Civil Liberties Union] to sue Alameda County and they won. In one jurisdiction, the judge said that if they wanted to enforce these American Plan laws, they’d have to enforce them equally against men and women, and so of course male officials stopped enforcing it. This betrayed the fundamental sexism of the program.

B: What happened in the 1980s with HIV/AIDS vis-à-vis the American Plan?

S: It’s important to remember that all of the American Plan laws remain on the books in some form to this day. In the early eighties, when the epidemic broke out, there were surprisingly few calls for quarantine. That was because people thought AIDS was something only a couple populations could get—gay men, Haitians, IV drug users, and hemophiliacs, the so-called Four-H’s. But a couple explosive media incidents happened in 1984 and 1985 — including the death of Rock Hudson, and the widely publicized arrest of a sex worker in New Haven, Connecticut — that led the general population to believe that they too were at risk, that straight people too might get this. That launched in mid-1985 a state of incredibly punitive attempts to police those with AIDS or those suspected of having AIDS, especially prostitutes and sex workers. And officials repeatedly said, “we have these laws on the books from the American Plan, maybe we should use them again.” And so you saw dozens of states across the country consider quarantining people on a large scale. Polls suggested that huge numbers of Americans supported that. Many states specifically added AIDS to the list of conditions that could be quarantined. And there were a handful of cases of quarantine across the country, mostly of sex workers. Thankfully, it was not put in place on any broad scale—in part because of the activism of sex workers and people with AIDS themselves, who launched protests and did their own studies and who in very real ways fought back.

B: The officials implementing the Plan cited concerns over public health. How credible do you think those claims were?

S: For much of the twentieth century—before the advent of sulfa drugs and penicillin—STIs did run rampant. Huge percentages of people had syphilis or gonorrhea. They were difficult to treat and they were unpleasant. There is reason to believe that syphilis and gonorrhea were among the largest causes of disability that the American army suffered during WWI and around that time.

That said, this program made no sense at all from a public health standpoint. For one, if you’re going to quarantine people to prevent a transmissible infection, it doesn’t make sense to quarantine just half the public—that is, women but no men. There were a couple men incarcerated under the plan, but very few. It’s not a sensible approach to public health. Rather, it’s a means of controlling women. Second, the ostensible reason they were incarcerating women was to treat them for STIs. But they did not have effective treatments back then. The most common treatment at the time was an injection of mercury. Another common treatment was an injection of arsenic-based drugs. These things did very little to cure you of your infection. They did, however, hurt tremendously, and caused all kinds of terrible, painful side effects. And, if continued long enough, they could kill you.

It’s also important to remember that the diagnostic mechanisms for syphilis and gonorrhea were very flawed at the time. There’s reason to believe that the Wasserman examination, which was the most common blood test for syphilis at the time, could have a false positive rate up to 25 percent. The test for gonorrhea involved the visual inspection of microscopic slides, which was notoriously unreliable. So again, from a public health standpoint, this just doesn’t make sense.

B: But did people think that at the time? As you cite, there were many studies showing, we now know erroneously, that 90 percent of sexually transmitted infections were transmitted by prostitutes.

S: Those studies were based on flawed science, and there are a number of scholars who have demonstrated that. People were not aware generally that the diagnostic techniques were really pretty unreliable. That was not widely known. The limitations on the medical treatment were fairly well known. And it’s important not to look back at historical actors like physicians and think, “Boy, people used to be so stupid.” That’s not a sensible approach to the history of medicine; it’s not a sensible approach to history. But people were generally aware that there were extreme limitations to what they could accomplish with these medical treatments. And there are instances in which you see people talk about or write about the incarceration of women as a form of punishment and not as a form of treatment.

There’s an example of a health agent in California saying to a lawyer, “If I wanted, I could go arrest your wife.” It was clearly used as a tool of power. It was fundamentally about controlling women, about controlling infection.

B: If it’s unproductive to say historical actors were stupid, is it productive then to say that they were misogynistic, racist, classist?

S: I think the answer is yes. But I think it’s important not to see them as uniquely or distinctly misogynistic, or racist, or classist. Because that risks celebrating who we are right now. In my opinion, our society remains fundamentally sexist and racist and classist. It’s important to honestly assess people in the past, even people who we lionize, like Earl Warren or Eleanor Roosevelt, because it’s important to see these continuities, see how the carceral regime that began in the early twentieth century has effects to this day, and the philosophy that it cemented about women persists to this day. We still disproportionately police women who sell sex and arrest the men who purchase that sex at a much, much lower rate, . We still disproportionately detain women of color for these crimes. And very importantly, the physical facilities that housed women under the American Plan in many cases exist to this day. There are continuities here we should remember.

B: What about Eleanor Roosevelt, someone widely regarded as a champion of civil rights? She’s not portrayed flatteringly in your book. What are we to do with someone like her?

S: We should treat Eleanor Roosevelt as someone of her time, and at her time an elite woman like herself would’ve had very negative impressions of sexually promiscuous women, of sexually liberated women. At the same time, though, Eleanor Roosevelt was a person with agency. She certainly had the ability to make her own choices and in this case made profoundly wrong choices. She raised money for an organization that was integral to the incarceration of thousands of women. She was at meetings at which federal agents talked about locking up thousands of women, and she did not object. She was totally aware of the American Plan and did not speak out, while she was speaking out about a number of other social ills, a number of other bigoted programs. So while we should not treat her as some sort of uniquely evil figure, and we should remember all the good that she did, we should also see her as having done some less than good things, and see her as fundamentally a product of her time and place and class, which is to say a somewhat close-minded person.

B: You write that the story of the American Plan has not just been forgotten but actively buried. How?

S: First, there’s the intentional suppression of the free speech of these women. There are a number of cases in which they were denied access to counsel. Most facilities that incarcerated these women refused to allow visitors so they couldn’t tell people what was happening. Their mail was read, and so they couldn’t write what was truly happening when they were inside these facilities. In all those ways, their stories were buried.

Probably more importantly, elite men and women played a role in the maintenance of a culture that so stigmatized incarceration, sexually transmitted infections, and sexual promiscuity that women simply weren’t able to talk about this. It was too stigmatized. They wouldn’t be able to get jobs if they talked about this. They certainly wouldn’t be able to find partners if they talked about this. And newspapers simply wouldn’t print these words in a lot of cases. In all these ways, their stories have not just been forgotten but intentionally obscured.

B: You don’t buy that these local enforcers were simply doing their job as ordered from on high, that they were foot soldiers in a war that wasn’t their making.

S: No, I don’t, because this literally wasn’t coming from on high. It may have started as a top-down program during World War I but officials continued to enforce this from the twenties through the sixites. And they could have stopped it at any time. But they didn’t, because they didn’t see anything wrong with this. In fact, officials male and female believed they were helping these women. They knew what they were doing, they made choices, they had agency, of course we should view them as products of their time but it’s also important to view them as people with the ability to choose. And they chose to lock thousands of women up in what some women called concentration camps.

B: How do you uncover this story and not emerge deeply pessimistic?

S: You do become incredibly pessimistic, and there’s no escaping that. How would you feel if your sister, or your mother, or your girlfriend were walking down the street and were detained, examined in the most personal way imaginable, and then locked away without a trial, for months, to be pumped full of poison and then released and told that she was less-than? How would you feel? It’s profoundly unfair, and I think everyone can grasp that.

We’ve been taught so many mythologized and sanitized versions of history that it’s depressing, I think, to read what actually happened. What uplifts me at the end of the day is the resistance from the women who were incarcerated. The fact that people fought back against great odds and in some cases won, and even when they lost continued to fight back, and that people fight back to this day—that’s what gets me out of bed in the morning.